Relative Incidence of Proximal Fibula Fractures with Tibial Plateau Fractures: An Investigation of 354 Cases

Abstract

We aimed to investigate the incidence of proximal fibula fractures in patients with tibial plateau fractures and to identify risk factors for such combined injuries. From January 2011 to December 2015, 354 patients with tibial plateau fractures who had been admitted to a level 1 trauma center were retrospectively evaluated by an orthopaedic trauma surgeon and two skeletal radiologists. Anteroposterior plain radiography and computed tomography (CT) were used to characterize the injuries, and the incidence of associated proximal fibula fractures was determined. The tibial plateau fractures were classified according to the Schatzker's and three-column classifications. Associated proximal fibula fractures were simultaneously classified with a new fibula fracture classification system. Finally, we determined whether there were statistically significant associations between the presence of a proximal fibula fracture and different types of tibial plateau fractures, as well as sex and age. Proximal fibula fractures were detected in 192 (54.24%) patients using plain radiography and in 215 (60.73%) patients using CT. Logistic regression analysis indicated an increasing trend in the incidence of fibula fractures detected by the CT-based three-column classification system as follows: “age × sex > three columns > age > single posterior column > lateral column + posterior column > medial column + posterior column > medial column + lateral column > single lateral column > single medial column.” Proximal fibula fracture associated with tibial plateau fracture is a common phenomenon worthy of attention. In women, age increases the likelihood of complex tibial plateau fractures, particularly those involving the posterolateral articular surface and diaphysis, as well as the likelihood of developing proximal fibula fractures. This s Level IV diagnostic study.

Keywords

tibial plateau fracture - proximal fibula fracture - computed tomography - three-column classification - schatzker classification

^∗ Co-first author

• References

• 1 Kokkalis ZT, Iliopoulos ID, Pantazis C, Panagiotopoulos E. What's new in the management of complex tibial plateau fractures?. Injury 2016; 47 (06) 1162-1169
• 2 Rademakers MV, Kerkhoffs GM, Sierevelt IN, Raaymakers EL, Marti RK. Operative treatment of 109 tibial plateau fractures: five- to 27-year follow-up results. J Orthop Trauma 2007; 21 (01) 5-10
• 3 Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968--1975. Clin Orthop Relat Res 1979; (138) 94-104
• 4 Luo CF, Sun H, Zhang B, Zeng BF. Three-column fixation for complex tibial plateau fractures. J Orthop Trauma 2010; 24 (11) 683-692
• 5 Yang G, Zhai Q, Zhu Y, Sun H, Putnis S, Luo C. The incidence of posterior tibial plateau fracture: an investigation of 525 fractures by using a CT-based classification system. Arch Orthop Trauma Surg 2013; 133 (07) 929-934
• 6 Harris TE, Ruth JT. Operative management of fractures of the tibial plateau. Am J Knee Surg 2001; 14 (02) 129-134
• 7 Zhang P, Lian K, Luo D, Huang Z, Li T, Lin D. A combined approach for the treatment of lateral and posterolateral tibial plateau fractures. Injury 2016; 47 (10) 2326-2330
• 8 Adams Jr JD, Della Rocca GJ. Management of posterior articular depression in tibial plateau fractures. J Knee Surg 2016; 29 (01) 28-33
• 9 Ozdemir G, Yilmaz B, Oztermeli A. Open reduction and internal fixation of the isolated tibial lateral plateau posterior fracture using direct posterior split gastrocnemius approach. Case Rep Surg 2015; 2015: 530578
• 10 Griesser MJ, McCoy BW, Hussain WM, Saluan P. Bicondylar tibial plateau fracture after posterior cruciate ligament reconstruction. Orthopedics 2015; 38 (03) e240-e243
• 11 Chen H, Wu L. Surgical options for posterior tibial plateau fracture. Int J Clin Exp Med 2015; 8 (11) 21421-21427
• 12 Bozkurt M, Yilmaz E, Atlihan D, Tekdemir I, Havitçioğlu H, Günal I. The proximal tibiofibular joint: an anatomic study. Clin Orthop Relat Res 2003; (406) 136-140
• 13 Bozkurt M, Turanli S, Doral MN. , et al. The impact of proximal fibula fractures in the prognosis of tibial plateau fractures: a novel classification. Knee Surg Sports Traumatol Arthrosc 2005; 13 (04) 323-328
• 14 Bickels J, Kollender Y, Pritsch T, Meller I, Malawer MM. Knee stability after resection of the proximal fibula. Clin Orthop Relat Res 2007; 454 (454) 198-201
• 15 Takeda A, Tsuchiya H, Mori Y, Tanaka S, Kikuchi S, Tomita K. Anatomical aspects of biopsy of the proximal fibula. Int Orthop 2001; 24 (06) 335-337
• 16 Weigel DP, Marsh JL. High-energy fractures of the tibial plateau. Knee function after longer follow-up. J Bone Joint Surg Am 2002; 84-A [phone]
• 17 Katsenis DL, Dendrinos GK, Kontos SJ. High energy tibial plateau fractures treated with hybrid fixation: is knee bridging necessary?. Orthopedics 2006; 29 (04) 355-361
• 18 Khatri K, Lakhotia D, Sharma V, Kiran Kumar GN, Sharma G, Farooque K. Functional evaluation in high energy (Schatzker type V and type VI) tibial plateau fractures treated by open reduction and internal fixation. Int Sch Res Notices 2014; 2014: 589538
• 19 Markhardt BK, Gross JM, Monu JU. Schatzker classification of tibial plateau fractures: use of CT and MR imaging improves assessment. Radiographics 2009; 29 (02) 585-597
• 20 Chang SM, Zhang YQ, Yao MW, Du SC, Li Q, Guo Z. Schatzker type IV medial tibial plateau fractures: a computed tomography-based morphological subclassification. Orthopedics 2014; 37 (08) e699-e706
• 21 Patange Subba Rao SP, Lewis J, Haddad Z, Paringe V, Mohanty K. Three-column classification and Schatzker classification: a three- and two-dimensional computed tomography characterisation and analysis of tibial plateau fractures. Eur J Orthop Surg Traumatol 2014; 24 (07) 1263-1270